Providers scramble as Tennessee tells sick, disabled immigrant kids they will be reported

Last week Gov. Bill Lee’s administration issued an ultimatum to hundreds of immigrant families in Tennessee: 

If parents wished to keep their disabled and critically ill children on a last-resort medical program, their personal information would be turned over to a state agency that shares data with Immigration and Customs Enforcement.

The notice, targeting immigrant children without permanent legal status, came with a June 30 deadline and no transition plan for young patients who rely on ventilators and feeding tubes, or who are midway through chemotherapy treatment — healthcare that, until now, has been provided through the Children’s Special Services program. 

The decision prompted a sprint last week by public health workers to figure out ongoing care. Democratic lawmakers pressed the Tennessee Department of Health for details. The Tennessee Chapter of the American Academy of Pediatrics urged pediatricians across the state to send urgent letters and sign a petition. 

The Tennessee Justice Center, a nonprofit legal advocacy firm, searched for plaintiffs willing to join a legal challenge. As of Friday, they had not found a family willing to join. Even if parents are not fully identified in public court filings, their identities would have to be shared with lawyers defending the state during the course of litigation, said Michele Johnson, executive director.

Families are “so scared,” Johnson said.

“I can’t overstate the impact we’re seeing,” Dr. Morgan McDonald, who sits on Nashville’s Metro Health Board, said during a Thursday board meeting. 

“We’re seeing nurses scramble for ventilators, for feeding tubes, to try (to obtain) metabolic formula, to try to keep kids out of the hospital, to try to keep kids alive,” she said.

Public health staff have been “working around the clock to not let any child fall through the cracks, but the resources are fewer and fewer for these families,” she said.

About 400 families enrolled in the Children’s Special Services program received notice last week, according to an email from the Tennessee Department of Health — shared with the Lookout — that was sent from the state health department to Sen. Heidi Campbell, a Nashville Democrat. The email came in response to Campbell’s demand for more details from the department last week. The department did not respond to the Lookout’s request for more information about the letters last week.

Among those impacted is a 10-year-old boy with complex medical conditions including spina bifida, autism and kidney disease who has been enrolled in Children’s Special Services for seven years, according to his mother, Gabriella. She asked to be identified only by her first name because she fears her family being targeted by immigration officials for speaking publicly. Their asylum claim is pending.

On Saturday, Gabriella sat at her kitchen table as her son sat in his wheelchair in front of the TV watching cartoons.

She and her husband have decided to withdraw their son from the program, she said. Her 8-year-old daughter and 4-year-old son put their arms around their mother as she dropped her face into her hands and cried.

“We are not comfortable today,” she said. “We have no other choice. We have to take him from Children’s Special Services. Because I see in the news that they don’t care. I see them taking a mother with a baby. I don’t want to put the life of my children in their hands. I don’t want immigration to come to my house. I don’t want them to put us in detention. In detention (my son) wouldn’t get any care.”

“I don’t understand why they are doing this to these kids, not just my own.” 

Tennessee health department warns parents their children will be reported to immigration officials

She paused as she searched for the right words in English, taking out her phone to type into a translation program.

“They are innocent children,” the translation text read. 

Gabriella and her husband sought asylum in the United States after leaving Honduras seven years ago to escape violence, she said. She said she prays every day for the asylum claim to be granted. If they obtain asylum, they will re-enroll their son in the Children’s Special Services program, she said. 

In the meantime, she said her social workers at the public health department and Vanderbilt University Medical Center have told her they are doing everything they can to find other means to deliver her son’s medication, medical care and supplies.

‘Sickest of the sickest of the sickest’

Children’s Special Services is a decades-old, public program for kids with disabilities, chronic illnesses and, in some instances, terminal diagnoses. 

The program serves the “sickest of the sickest of the sickest” children who are uninsured or underinsured, Johnson said. The program, administered through each of the state’s 95 local health departments, helps pay for hospitalizations, specialists, therapists, medications, medical supplies, social workers and in-home care to help families navigate their children’s complex care needs regardless of immigration status. 

In total, more than 4,600 children across the state are enrolled.

The state health department’s decision to require immigration checks has been brewing for months, with local public health officials working behind the scenes to try and avert it.

State health officials opted to move forward with the verification policy in early June. 

In letters that reached families last week, Department of Health Interim Commissioner John Dunn wrote that “due to the current immigration status of your child … if the Children’s Special Services program keeps paying for healthcare after June 30, 2026, the Tennessee Department of Health will share your child’s information” with the state’s Department of Safety and Homeland Security. 

Tennessee to report disabled immigrant kids getting public healthcare to ICE, advocates say

The letters to parents cited a new state law the department said required the reporting of immigrants seeking or receiving public benefits who do not have a legal permanent status in the United States to Tennessee’s Centralized Immigration Enforcement Division, which works closely with Immigration and Customs Enforcement.

Legal advocates for low-income patients strongly disputed the department’s interpretation of the law, which they said applies only to adults. 

On Friday, one of the two Republican sponsors of the legislation endorsed the health department’s application of the law, suggesting emergency rooms as an alternative for children in the program.

“No child receiving lifesaving medical treatment is denied care because of this new law,” Rep. Dennis Powers, a Jacksboro Republican, said. “Federal protections for emergency and lifesaving medical services remain fully in place regardless of immigration status, criminal status or insurance.

The legislation, Powers said, “simply ensures taxpayer-funded public benefits are reserved for those who are legally eligible to receive them.” 

“That’s not so easy,” Gabriella.  She walked through her son’s bedroom, stacked with catheters, gloves and diapers. She picked up bottles of medication to treat her son’s kidneys and to prevent infection. A lift in one corner helps get her son, who weighs 120 pounds, out of bed. Leg braces, replaced annually to keep up with his growth, lay on the bed. 

Her son “needs therapies and the doctor that we cannot afford. The emergency room does not help with these things.”

“Please tell people that my husband pays taxes,” she said. “We are not trying to take anything from other people. We are just trying to help our son, as any parent would.”

Pediatricians and public health providers have warned of dire and even life-threatening consequences for children who withdraw from the program rather than risk being reported to immigration authorities. 

Dr. Jason Yaun, past president of the Tennessee Chapter of the American Academy of Pediatrics, said Friday that he was taken by surprise when he learned that immigrant children’s care is in jeopardy.

Yaun said the pediatric academy is preparing letters to the state, asking Tennessee pediatricians to sign onto a petition and join efforts already underway to push back against the state’s plan.

“My big fear is without Children’s Special Services that many of these children with very complex conditions will not be able to access the care they need, especially specialty and ancillary care,” he said. 

“All the children on this program are typically cared for by specialists and need multiple ancillary services, early intervention and ongoing therapies to keep them thriving and healthy. Many of these children have in the past, or will in the future, require major surgeries and procedures.”

The Tennessee Department of Health did not respond to repeated requests for information about the immigration verification checks from the Lookout last week. 

On Friday, Campbell said the department had also stopped responding to her questions, citing potential incoming litigation.

“The Tennessee Department of Health is now refusing to answer a sitting state senator’s questions about whether 400 seriously ill children were swept into immigration reporting beyond what the law requires, and hiding behind litigation to do it,” Campbell said. 

“TDOH receives state appropriations. Legislators have both the right and the obligation to know how those funds are being used and whether agencies are operating within statutory authority.”

Gabriella said she and her husband are placing their faith in God. 

Since May 2026, as mass immigration sweeps in Nashville detained more than 100 people, Gabriella said she and her husband only travel together by car together to church on Sundays. They otherwise drive separately in case one of them is detained so their children do not lose both parents. 

Each day, when her husband leaves for work as a marble and slab layer, they embrace and say a shared prayer for his safe return, she said.